<div class="container">
    <div id="form1">
        <form class="form-horizontal" role="form" id="form_submit" method="POST">
            <legend><h3>特殊申请</h3></legend>
            <div class="form-group">
                <label for="applyName" class="col-sm-2 control-label"> 姓名：</label>
                <div class="col-sm-10">
                    <input type="text" class="form-control" id="applyName" placeholder="申请人姓名"name="name">
                </div>
            </div><br>
            <div class="form-group">
                <label for="inputEmail3" class="col-sm-2 control-label"> 使用时间:</label>
                <div class="col-sm-10">
                    <div class="row">
                        <div class="col-md-4">
                            <!-- <input type="text" class="form-control" id="inputEmail3" placeholder="年 "name="year"> -->
                            <select name="year" id="ay" class="form-control"></select>
                        </div>
                        <div class="col-md-4">
                            <!-- <input type="text" class="form-control" id="inputEmail3" placeholder="月 "name="month"> -->
                            <select name="month" id="am" class="form-control"></select>
                        </div>
                        <div class="col-md-4">
                            <!-- <input type="text" class="form-control" id="inputEmail3" placeholder="日 "name="day"> -->
                            <select name="day" id="ad" class="form-control"></select>
                        </div>
                    </div>
                </div>
            </div><br>
            <div class="form-group">
                <label for="det" class="col-sm-2 control-label">补充说明: </label>
                <div class="col-sm-10">
                    <input type="textarea" class="form-control" id="det" placeholder="需要另外说明的" name="detail">
                </div>
            </div><br>
            <div class="form-group">
                <div class="col-sm-10 col-sm-offset-2">
                    <button type="submit" class="btn btn-success" id="button">提交</button>
                    <button type="reset" class="btn btn-primary">重置</button>
                </div>
            </div>
        </form>
    </div>
</div>